ABO血型不合造血干细胞移植后患者早期输血质量控制

目的 探讨ABO血型不合的异基因造血干细胞移植(HSCT)后早期输血质量控制方法,确保HSCT顺利进行.方法 对23例HSCT患者进行早期输血治疗,做好输血前、中、后期输血管理及血液保存的质量控制.结果 23例ABO血型不合的HSCT后均获得了造血重建,血型分别于移植后24～150 d转为供者血型;无1例发生溶血反应.结论 严格输血管理,可以帮助HSCT患者顺利实现造血功能重建.     

ABO血型不合异基因造血干细胞移植

目的 探讨ABO血型不合异基因造血干细胞移植(Allo-HSCT)的疗效及并发症。方法 6例患者中1例ABO血型主要不合，5例次要不合；2例脐血，1例外周血干细胞，3例骨髓联合外周血干细胞；对主要不合者骨髓用重力沉降法去除红细胞，对次要不合骨髓以离心分离方法去除血浆，外周血造血干细胞及脐血未经处理直接输注。结果 6例均成功植入，仅在输注干细胞时发生短暂轻微溶血，而无延迟性溶血反应及移植后红系造血延迟。结论 ABO血型不合可顺利进行Allo-HSCT，获得干细胞的植入，移植前后防止溶血发生至关重要。     

ABO血型主要不合异基因造血干细胞移植后纯红细胞再生障碍的临床分析

目的探讨ABO血型主要不合者异基因造血干细胞移植（allo-HSCT）后并发纯红细胞再生障碍（PRCA）的危险因素、临床转归以及PRCA的治疗和预防。方法42例行allo-HSCT，其中供、受者AN）血型主要不合者33例，主次双向不合者9例，27例受者血型为O型。预处理后，13例行骨髓移植，25例行外周血干细胞移植，4例行脐血移植。6例移植前行供者型血浆置换。移植后采用环孢素A（CsA）及短程甲氨蝶呤（MTX）联用预防移植物抗宿主病（GVHD）。结果42例均获得供者细胞植入，11例移植后并发PRCA（26．2％），11例的血型均为O型，其供者9例为A型，2例为B型；移植前行供者型血浆置换的O型受者，移植后均未发生PRCA。并发PRCA的11例中，8例经红细胞输注后自然缓解，2例行供者型血浆置换，其凝集素滴度下降后缓解，1例予利妥昔单抗治疗后缓解。单因素分析表明，O型受者、A型供者以及A型供给O型者与PRCA的发生相关，多因素分析表明，A型供给0型者是发生PRCA的独立危险因素（RR为10．999，95％可信区间为1．975-61．258，P〈0．05）。结论A型供给O型者与PRCA的发生密切相关；移植前行供者型血浆置换可预防PRCA的发生；供者型血浆置换和利妥昔单抗可有效治疗PRCA。     

ABO血型不合对同胞异基因外周血干细胞移植的影响

目的探讨HLA配型相合但ABO血型不合的同胞异基因外周血干细胞移植(allo- PBSCT)治疗血液恶性肿瘤的疗效。方法对2001年6月至2005年9月的68例HLA配型相合的血液恶性肿瘤患者进行同胞allo-PBSCT,其中ABO血型不合30例(血型不合组),ABO血型相合38例(血型相合组)。急性髓细胞白血病(AML)、骨髓增生异常综合征(MDS)和慢性粒细胞白血病(CML)患者采用马利兰(BU)/环磷酰胺(CY)预处理方案；急性淋巴细胞白血病(ALL)和非霍奇金氏淋巴瘤(NHL)患者采用全身照射(TBI)/CY方案；多发性骨髓瘤(MM)患者采用TBI/CY/马法兰方案。移植物抗宿主病(GVHD)的预防采用霉酚酸酯(MMF)、环孢素A(CsA)和短程甲氨喋呤(MTX)三联方案。结果(1)除1例植入失败外,其余67例患者全部造血重建。中性粒细胞绝对值≥0．5×10~9/L和血小板数≥20×10~9/L的平均时间为移植后+12(+9～+15)d和+21(+15～+40)d,血型不合组与血型相合组植入的时间差异无统计学意义(P＞0．05)。(2)血型不合组均未出现急性溶血反应,但与血型相合组比较,红系造血延迟,在供/受者血型为A/O的7例患者中有3例(42．9%)发生纯红细胞再生障碍性贫血(PRCA)。血型不合组于移植后60d(24～153 d)血型成功转变为供者型。(3)随访至2005年9月30日,血型不合组急性GVHD发生率(20．0%)比血型相合组(2．6%)高(P=0．019),但慢性GVHD发生率、肝静脉栓塞综合征(VOD)发生率、巨细胞病毒(CMV)感染发生率、出血性膀胱炎(HC)发生率、疾病复发率及死亡率与血型相合组比较,差异无统计学意义(P＞0．05)。(4)用Kaplan-Meier生存分析发现,血型相合组和血型不合组患者之间预期4年的生存率差异无统计学意义(P＞0．05)。结论ABO血型不合可以进行allo-PBSCT,并且不影响干细胞移植的植活,虽然急性GVHD的发生率较血型相合组高,但其对复发率、死亡率及生存率无显著影响。     

供受体ABO血型不合肝移植

目的 探讨供受体ABO血型不合肝移植的治疗及效果.方法 回顾性分析武警总医院实施的9例ABO血型不合肝移植临床资料.1例病人术前行血浆置换.全部病例术中均采用显微镜下吻合肝动脉和胆道,5例病人术中切除了脾脏.全部病例采用了四联免疫治疗方案.术后注意保持氧饱和度大于95%,并加强抗凝治疗.结果 4例病人顺利恢复,无并发症.其余5例中,3例出现急性排斥反应,4例出现胆道非吻合口狭窄,3例病死.结论 当供体缺乏而受者病情不能等待时,可以进行供受体ABO血型不合肝移植,但应该尽量减少并发症发生.     

ABO血型不合肝移植研究进展

根据供／受体ABO血型配合情况，可以将其分为ABO血型相同、ABO血型相符和ABO血型不合。数据统计表明：ABO血型不合肝移植术后发生急性排斥反应、肝叶坏死和血管、胆道并发症均较血型相符者多。但是，肝脏作为一“免疫特惠器官”，对抗体介导的损伤有较好的耐受性，极少发生超急性排斥反应。匹兹堡UNOS肝移植登记处的资料显示，7000余例成人肝移植中ABO血型不合者占3％，在1500例小儿肝移植中占7％。在欧洲，8％的急诊肝移植为ABO血型不合。因此，在紧急或供体紧缺的情况下行ABO血型不合的肝移植已逐渐被接受。     

ABO血型不合的肾移植

进行ABO血型不合的肾移植，打破了传统的配型原则，为解决移植肾供体缺乏问题提供了新途径，近几年已有很多成功的经验。本文就ABO血型不合肾移植的排异、免疫抑制治疗等有关进展做一综述。     

ABO血型不合肾移植的研究进展及临床应用

ABO血型不合一直是肾移植发展的主要障碍之一，目前已有许多方法用于控制和避免ABO血型不合的移植排斥反应，延长移植肾的生存时间，保护移植肾的功能。这些方法有的已经在临床中应用并取得了良好的效果，如血浆置换或免疫吸附、脾切除术、免疫抑制剂等，有的尚处于研究阶段，如基因治疗、抗CD20单克隆抗体治疗等。本文就目前ABO血型不合肾移植的原理、主要的抗排斥反应措施的临床应用及评价作一综述。     

ABO血型不合肝移植研究新进展

复习国外文章关于ABO血型不相同的肝脏移植在A2型供肝使用,移植肝出现受体类型的ABO组织血型抗原,C4d作用和临床治疗上的新进展。A2型供肝能较安全的用于血型不合肝移植,毛细血管内表达r-ABOAg可能是移植物内皮损害和修复的表现,C4d阳性对血型不同肝移植治疗策略上是很好的参考物,但缺乏特异性,采用包括多联免疫抑制药和肝内灌注等综合治疗方法能有效预防排斥反应且能取得良好的预后。     

Relevance of Chimerism Analysis After Allogeneic Stem Cell Transplantation

Hematopoietic stem cell transplantation is a potentially curative therapy for a range of malignant and non-malignant hematological diseases. Analysis of chimerism following allogeneic stem cell transplantation has been a routine method for the assessment of engraftment and early detection of graft failure. Lineage-specific chimerism monitoring is progressively used to specifically detect chimerism in one or more cell subsets, which may be undetected in assessment of the whole leukocyte population. The chimerism study in different leukocyte subpopulations increases sensitivity and specificity in the monitoring after transplantation, especially the analysis of T lymphocytes. All peripheral blood samples were separated into mononuclear cells and granulocytes by Ficoll density gradient centrifugation and T, B, and CD34+ was separated by immunomagnetic automatic cell separator. After DNA extraction, chimerism monitoring was performed using short tandem repeat by multiplex polymerase chain reaction followed by capillary electrophoresis. Quantification of chimerism was performed by determining the ratio of peak areas from donor and recipient informative short tandem repeat. Donor-recipient chimerism analysis in patients after allogeneic stem cell transplantation is a practical, feasible, and useful tool that predicts clinical outcomes and provides a guide for suitable therapeutic interventions.     

数字减影全脑血管造影术的护理配合

回顾性总结46例数字减影全脑血管造影术的护理配合。提出术前全面评估病情、做好健康教育及心理护理，术中注重全身肝素化、严格执行无菌技术，密切观察术中、术后病情变化。积极采取有效的抢救措施是成功配合脑血管造影术的关键。     

异基因造血干细胞移植术后并发口腔粘膜炎患者的护理

21例接受异基因造血干细胞移植术的患者在移植术后并发口腔粘膜炎(OM)．对其进行护理。结果13例(61．9％)发生不同程度的OM。其中Ⅰ度2例。Ⅱ度7例,Ⅲ度3例。Ⅳ度1例。严重程度与术后OM发生时间相关,发生时间越早,OM越严重．愈合时间越长。经综合治疗、护理后。OM均于3～46d痊愈。提示加强观察与护理能够降低OM的发生率。减轻或缩短OM病程,提高患者的生活质量。     

The Impact of Early Rehabilitation on the Duration of Hospitalization in Patients After Allogeneic Hematopoietic Stem Cell Transplantation

Background

We examined the relationship between the improved physical activity by early rehabilitation and the duration of hospitalization among patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Methods

Thirteen allo-HSCT patients with myeloablative conditioning regimens (group A) and 13 patients with nonmyeloablative conditioning regimens (group B) were assessed retrospectively in this study. All patients received physical exercise immediately after neutrophil engraftment at the class 10,000 bioclean room (class 10,000). The mean daily steps at class 10,000 were measured as a substitute for the amount of physical activity, and the duration of hospitalization as one of the clinical outcomes.

Results

The degree of physical activity showed a negative correlation with the duration of hospitalization in group A (r = −.71; P = .0071), regardless of complications such as acute graft-versus-host disease, infections, and cytomegalovirus reactivation. However, there was no significant association in group B (r = .09; P = .77).

Conclusion

The improved physical activity through early rehabilitation may be an independent, favorable prognostic factor for allo-HSCT patients with myeloablative conditioning regimens.     

Intestinal Ischemia After Allogeneic Stem Cell Transplantation: A Report of Four Cases

Gastrointestinal ischemia after allogeneic bone marrow transplantation is a rare complication not well-described in the literature. Herein we retrospectively review charts of four patients who developed intestinal ischemia after allogeneic bone marrow transplantation at our institution. The patients were found to be predominately younger males who presented with nonspecific abdominal pain. Graft-versus-host disease was a common finding among all patients. Laboratory values suggestive of microangiopathy were present in two patients. Obesity and hypertriglyceridemia were cardiovascular risk factors found in these patients. The development of thrombotic microangiopathy and cardiovascular risk factors after allogeneic bone marrow transplantation may predispose patients to gastrointestinal ischemia and may portend a poor prognosis.     

同种反应性NK细胞在异基因干细胞移植治疗实体性肿瘤中的作用

干细胞移植(stem cell transplantation,SCT)是一种新兴技术,在多个临床领域有着广泛的应用.干细胞移植在肿瘤治疗领域的应用可分为两类:即大剂量化疗/放疗联合自体干细胞移植(autologous stem cell transplantation,Auto-SCT)和异基因干细胞移植(allogeneic stem cell transplantation,Allo-SCT)两大类.     

Kidney Disease After Allogeneic Hematopoietic Stem Cell Transplantation Is Associated With Decreased Physical Function

Objective/BackgroundAllogeneic hematopoietic stem cell transplantation (allo-HSCT) has improved outcomes and prognosis, but it has many complications and is associated with impaired physical function. To solve this problem, it is necessary to further analyze the factors that cause the decline in physical function. In the present study, we hypothesized that kidney disease following allo-HSCT would be associated with impaired physical function, in addition to conventional factors, and tested this hypothesis retrospectively.MethodsThirty-one patients who underwent allo-HSCT at the Department of Hematology in our hospital from January 2016 to October 2021 were included in the analysis. Correlation analysis and stepwise multiple regression analysis with change in 30-second sit to stand test (Δ30-s STS) as the dependent variable were performed to identify predictors of physical function decline from pretransplant to discharge.ResultsThe mean age of participants was 43.9 years (SD = 11.8), the mean time from transplant to discharge was 103.1 days (SD = 35.0), and approximately 30% of patients had kidney disease following allo-HSCT. All patients were ambulatory and independent at discharge, but 30-s STS was significantly reduced (P < .001). Among various factors, age (β = ?0.464, P < .05), total corticosteroid dose (β = ?0.380, P < .05), and kidney disease after allo-HSCT (β = ?0.307, P < .05) were the independent predictors of Δ30-s STS (R² = 0.592, adjusted R² = 0.547, F = 13.072, P < .01).ConclusionKidney disease after allo-HSCT is one of the factors that may contribute to poor physical function, and patients who experience this condition may require additional follow-up to improve physical function.